Campaign Participation Form

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Who We Are
Community Impact
How To Help
- Volunteer
  - Community Investment Committee
- Give Back
  - Workplace Campaigns
  - Help Starts Here

Who We Are
Community Impact
How To Help
- Volunteer
  - Community Investment Committee
- Give Back
  - Workplace Campaigns
  - Help Starts Here

Donate

GET HELP

Today's Date(Required)

Month

Day

Year

Company/Organization Name(Required)

Company/Organization Street Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Company/Organization MAILING Address (if different)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Number of employees(Required)

The actual number of local employees who are able to contribute to your United Way campaign

Is your business a part of a Union?(Required)

Yes

No

If yes, which union?

Local CEO/Leadership Name(Required)

Your President/CEO/Plant Manager/etc.

First Last

Local CEO/Leadership Job Title(Required)

Local CEO/Leadership Email(Required)

Finance/Payroll Contact(Required)

Please list the person who can answer questions about United Way deductions and payments

First Last

Finance/Payroll Contact Email(Required)

Employee Campaign Manager (ECM) Name(Required)

First Last

ECM Job Title(Required)

ECM Email(Required)

ECM Phone(Required)

How many ECMs does your company have?(Required)

I am the only employee campaign manager at my workplace

There are multiple employee campaign managers at my workplace

If you have multiple ECM's, please list their names and emails here.

Desired Campaign Start Date(Required)

Desired Campaign End Date(Required)

Workplace Campaign Goal

If you have a goal for this upcoming campaign, please list it here. This goal could be monetarily, increase in participation or education.

United Way Committee(Required)

Some companies have an internal committee specifically for their United Way Campaign. This could also be a culture committee or something similar, but the United Way campaign is organized through this committee.

Yes, we have a United Way committee at my workplace

No, we do not have a United Way committee at my workplace

We do not have a United Way committee at my workplace, but I am interested in setting one up

If you do have a United Way committee, please list all of the committee members names and emails here

This will enable us to add these committee members to our monthly ECM Newsletter!

Pledge Form Preference(Required)

We can offer you pledge forms in many ways. Paper, fillable PDF, online, or a mixture of options depending on your workforce. Fillable PDF forms are available in both English & Spanish.

Paper Pledge Forms

Fillable PDF Pledge Form

Online Pledge Form

None, we create our own Pledge Forms

Mix of paper and digital Pledge Forms

Spanish Forms

Number of Paper Pledge Forms Needed(Required)

If you need paper pledge forms, please let us know how many you will need for your upcoming campaign

Would you like to schedule a Campaign Planning Meeting with United Way staff?(Required)

Yes

No

Unsure, please contact me to discuss